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Renal 2 > Tubular And Interstitial Diseases > Flashcards

Tubular And Interstitial Diseases Flashcards

1
Q

What are the two causes of acute tubular necrosis?

A

Ischemia and toxins

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2
Q

What are seen in the urine as a tip off for acute tubular necrosis?

A

Dirty brown casts

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3
Q

What are areas are most affected in toxic acute tubular necrosis?

A

Proximal convoluted tubules.

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4
Q

What are the most commonly damaged structures in ischemic acute tubular necrosis?

A

The renal tubules are sensitive to ischemia.

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5
Q

What are the clinical features of acute tubular necrosis?

A
  • Decreased GFR
  • Oliguria with brown dirty casts
  • Increased BUN:Creatinine
  • Hyperkalemia with metabolic acidosis
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6
Q

What are the characteristics of acute tubulointerstitial nephritis?

A

Histologically is characterized by interstitial edema, leukocytic infiltration of the interstitium and tubules, and tubular injury.

  • eosinophils in the urine*
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7
Q

What is a common cause of acute tubulointerstitial nephritis?

A

Immune mediated reaction to drugs.

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8
Q

What are the characteristic findings in chronic tubulointerstitial nephritis?

A

Infiltration with mononuclear leukocytes, interstitial fibrosis, and tubular atrophy.

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9
Q

What are the characteristic findings in acute pyelonephritis?

A

Hallmark–> patchy interstitial supparative inflammation, intratubular aggregates of neutrophils, tubular necrosis.

WBC casts on UA

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10
Q

What is the most common cause of clinical pyelonephritis?

A

Ascending infection.

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11
Q

What is always seen in the aftermath of pyelonephritis?

A

Fibrosis of the underlying renal pelvis and calyces

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12
Q

What are the symptoms that a patient will present with in pyelonephritis?

A

Fever, flank pain, WBC casts, and leukocytosis.

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13
Q

What allows bacteria to ascend the ureter into the renal pelvis?

A

Impotence of the vesiculoreteral valve.

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14
Q

What are the characteristic findings in chronic pyelonephritis?

A

Interstitial fibrosis and atrophy of tubules due to multiple bouts of acute pyelonephritis.

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15
Q

What findings in the kidney will chronic pyelonephritis lead to?

A
  • Lumpy-bumpy scaring of calyces and pelvis, dilated blunted calyces, dilated calyces and pelvis.
  • Corticomedullary scaring.
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16
Q

What symptoms will a patient present with in Tubulointerstitial nephritis that is caused by drugs?

A

Fever, rash, eosinophilia, and acute renal failure.

17
Q

What are three potential complications that can arise from acute pyelonephritis?

A

Papillary necrosis–> diabetics, sickel-cell patients.

Pyonephrosis–> seen in total or almost total obstruction in the urinary tract.

Perinephric abscess–>extension of the suppurative inflammation through the renal capsule into the perinephric tissue.

18
Q

What are the characteristic findings in analgesic nephropathy?

A
  • papillary necrosis.
  • edema and infiltration by mononuclear cells.
  • interstitial fibrosis can be seen in the medulla.
19
Q

Why are NSAIDS of concern in analgesic nephropathy?

A

The kidney expresses COX-2 and inhibition of this can lead to vasoconstriction and ischemia.

20
Q

What are the 3 phases of ATN and what are the findings in each phase?

A

1) initiation- slight raise in BUN, oliguria may be present
2) maintenance - decreased urine output, NaCl and H2O overload, increased BUN, HyperK, metabolic acidosis
3) recovery- steady increase in urine volume with HypoK, slow return to normal with an increased susceptibility to infection

21
Q

What are the findings that differentiate Tubulointerstitial nephritis from other glomerular diseases?

A
  • absence of nephrotic/ nephritic syndromes

- presence of defects in tubular function-saltwasting, metabolic acidosis etc.

22
Q

What are the organisms that are commonly responsible for pyelonephritis?

A

E. Coli, proteus, klebseilla, enterobacter from fecal flora.

23
Q

What is the diagnostic clue into chronic pyelonephritis and analgesic nephropathy?

A

Involvement of the calyces

24
Q

What is the cause of light chain cast nephropathy?

A

Accumulation of immunoglobin light chains (Bence-jones proteins). This can lead to renal dysfunction and CRF

25
Q

What are the morphological changes seen in light chain nephropathy?

A

Bence-Jones casts which are pink/blue amphourous masses concentrically laminated and fill tubular lumens.

26
Q

What is a common cause of papillary necrosis if a “pale gray necrosis limited to the papilla” was seen on exam of the kidney?

A

Diabetes Mellitus

27
Q

What is a common cause of papillary necrosis if a “red-brown necrotic papilla sloughed into calyx” was seen on exam of the kidney?

A

Analgesic Nephropathy

28
Q

What are two major predisposing conditions for development of chronic pyelonephritis?

A

Chronic obstructive pyelonephritis

Reflux Nephropathy

Renal 2 (6 decks)

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